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----- Original Message ----- From: "Kelly Grant" <[log in to unmask]> To: <[log in to unmask]> Sent: Saturday, December 16, 2000 9:47 AM Subject: Sleep disorders & fatigue in PD > Howdy Folks > This write-up goes with the list of "non-motor" PD smptoms. > > Sleep Disorders in PD > We spend over one third of our lives in sleep. The daily time spent sleeping > decreases as we age. No one is exactly sure why we sleep, but it is felt > that sleep is necessary to "recharge" the brain for the next day's > activities. We have all had nights of little or no sleep and it is obvious > that thinking and functioning the day after can be very difficult. > Sleep disturbances are a prominent part of PD. Often times it is difficult > to fall asleep and once asleep there are frequent awakenings. The need to > frequently urinate (see below) may also disrupt what would be a good night's > sleep. Once awake, it becomes harder to fall back asleep. This interference > in the normal sleep patterns results in increased sleepiness or somnolence > during the daytime hours. The sleep-wake cycle then becomes fragmented, with > poor sleep during the night and excessive sleep during the day. > Treatments of these sleep disturbances include simple measure such as > attending to good "sleep hygiene." This refers to avoiding such things as > alcohol, caffeine, nicotine, and excessive fluid intake prior to bed. Also, > increasing activity during the day may lead to more restful sleep at night. > Occasionally, medications can be used during the day to decrease excessive > daytime sleepiness. These medications are stimulants and although they can > be helpful in some cases, they may have some serious adverse effects. > Extremely vivid dreams can occur as a common side effect of medications used > to treat the motor symptoms of PD. These dreams may be so vivid and real > that family members or caretakers may think that the patient is > hallucinating, delusional, or demented. A patient who is not psychotic or > demented will soon realize, after several episodes, that these are dreams. > If these dreams become particularly bothersome, reducing the nighttime dose > of L-dopa or dopamine-agonist may alleviate this side effect. Otherwise, > patients, family members, and caretakers should be assured that these dreams > are due to medication effects and are not a sign of dementia or psychosis. > There are disorders of sleep that are closely associated with PD. One such > disorder is called REM (rapid eye movement) behavior disorder. REM sleep is > that stage of sleep in which dreams occur. In normal people there is an > inhibition of muscle tone, which functions as a protective mechanism during > REM sleep. In REM behavior disorder the inhibition of that tone is loss. > This leads to the outward expression of behaviors such as laughing, > screaming, kicking, punching, etc. Spouses may be at risk for bodily harm > and may have to sleep in another bed or part of the house. Patients who have > this disorder will usually go on to develop some signs and symptoms of > parkinsonism. Likewise, PD patients when studied in a special sleep > laboratory may demonstrate features of REM behavior disorder too. REM > behavior disorder can be effectively treated with low doses of a medication > called clonazepam. > Yet another sleep disorder seen frequently in association with PD is > restless leg syndrome (RLS). This is a peculiar disease in which there is a > feeling that one needs to move their legs. Movement of the legs typically > alleviates the sensation of restlessness. The symptoms of RLS usually > respond very well to treatment with L-dopa or the dopamine agonists, the > same medications used to treat the symptoms of PD. > An important point is that having PD does not exclude someone from having > common problems of sleep disturbance, such as obstructive sleep apnea (OSA). > The word "apnea" means "no breath" and the obstruction is often times due to > structural abnormalities of airway or neck. OSA can be a complication of > obesity. OSA is the most common cause of excessive daytime sleepiness. OSA > is characterized by lapses in breathing for periods of time during the > night. During these breathing lapses the brain is deprived of oxygen. > Usually, following these episodes the patient is jolted out of sleep to take > a breath. This occurs frequently during the night and results in a severe > disruption of normal sleep. OSA responds very well to devices that assist in > overcoming the obstruction to airflow, resulting in a great improvement in > daytime wakefulness and alertness. > > Fatigue > The feeling of fatigue is an extremely common symptom in PD. In some studies > fatigue occurs in almost one-half of all patients with PD and sometimes > fatigue may be the first symptom of the disease. It is important to separate > fatigue from the depression frequently seen with PD. Fatigue may accompany > depression, but also it may be present without any of the other signs or > symptoms of depression. Additionally, fatigue may naturally arise from > disruption of sleep. If fatigue a part of the spectrum of a depressive > symptom, then treatment of the fatigue should focus on treatment of the > underlying depression. If the fatigue is a result of sleep disturbance, then > treatment of the sleep disturbance should lead to an improvement in energy > levels. Sometimes, it becomes necessary to use a class of medications termed > "pscychostimulants," like amphetamines, to treat the underlying fatigue.